Remote Work Risk Assessment Form
Assess remote-work setup risks and identify any ergonomics, environment, or scheduling concerns before work begins.
Remote Work Environment
Work location type
*
Home office
Shared home space
Coworking space
Other
Dedicated workspace available?
*
Yes
No
Overall environment suitability
*
1
2
3
4
5
Ergonomics and Equipment
Ergonomics and Equipment Assessment
*
Rows
Yes
No
N/A
Chair support is adequate
1
2
3
Desk height is appropriate
4
5
6
Monitor is at a comfortable eye level
7
8
9
Keyboard and mouse are set up ergonomically
10
11
12
Lighting is sufficient for work
13
14
15
Internet connection is reliable
16
17
18
Overall workstation ergonomics rating
*
1
2
3
4
5
Missing equipment or adjustments needed
Work Pattern and Risk Follow-Up
Expected Weekly Remote Work Frequency
*
1-2 days
3-4 days
5 days
Occasional
Other
Primary Work Hours and Time Zone Compatibility
Final Risk Level Assessment
*
Low
Medium
High
Additional Notes or Mitigation Actions
Submit
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